维持性血液透析患者甲状腺功能减退症与贫血的临床相关性分析

Clinical analysis of hypothyroidism and anemia in patients with maintenance hemodialysis

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状腺功能减退症(简称甲减)的发病情况,分析甲减与肾性贫血的相关性,探讨积极治疗甲减后肾性贫血的改善情况。方法对2005年7月至2012年7月在解放军第三二三医院透析中心接受MHD的患者甲状腺功能情况进行回顾性调查研究。使用Pearson’s相关分析÷2检验和Mann-WhitneyU检验分析MHD患者甲减与临床特点的相关性,logistic回归分析用于贫血危险因素分析,配对t检验用于分析治疗甲减前后患者贫血状况的差异。结果所有274例透析患者中,19例(6.9%)有甲减,其中,男性发病率4.9%(7/142),女性发病率9.1%(12/132)。非甲减患者的血红蛋白水平高于甲减患者(u=15.262,ν=∞,P<0.001)。logisitic回归分析表明Kt/V、血清铁蛋白、甲功与患者贫血具有相关性。配对t检验(t=5.115,ν=18,P<0.0001)提示治疗甲减前后,患者血红蛋白含量有明显差异。结论 MHD患者更容易并发甲减,而甲减与患者血红蛋白含量有相关性,积极治疗甲减,可能有助于改善患者的贫血状况。

Objective To analyze the prevalence of hypothyroidism and its relevance to anemia in maintenance hemodialysis （MHD） patients. Methodology Clinical records of MHD patients treated in this hemodialysis center during the past 7 years （July 1, 2005 to July 1, 2012） were retrospectively studied using the statistical methods of chi-square test and Mann-Whitney U test. Correlation coefficient between hypothyroidism and anemia was assessed by logistic regression analysis. Paired t-test was used to evaluate change of anemia before and after hypothyroidism treatment. Results In the 274 MHD patients in this study, 19 patients （6.9%） including 7 males （4.9% in male patients） and 12 females （9.1% in female patients） had hypothyroidism. Patients without hypothyroidism were found to have higher hemoglobin levels than those with hypothyroidism （u=15.262, v= ∞ p 〈 0.001）. Logistic regression demonstrated that Kt/V, ferritin and hypothyroidism were statistically correlated with anemia. Paired t-test revealed that hemoglobin increased significantly after hypothyroidism treatment （t=-5.115, v=18, P 〈 0.0001）. Conclusion The prevalence of hypothyroidism was relatively higher in MHD patients. Hypothyroidism was correlated with anemia, and the treatment of hypothyroidism may aslo be helpful for the improvement of anemia in MHD patients.